The frequency and clinical associations of opioid use in systemic sclerosis

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2024

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Fairley, J.L.
Hansen, D.
Proudman, S.
Sahhar, J.
Ngian, G.-S.
Apostolopoulos, D.
Walker, J.
Host, L.V.
Stevens, W.
Ferdowsi, N.

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Rheumatology Advances in Practice, 2024; 8(4):rkae144-1-rkae144-6

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Jessica L. Fairley, Dylan Hansen, Susanna Proudman, Joanne Sahhar, Gene-Siew Ngian, Diane Apostolopoulos, Jennifer Walker, Lauren V. Host, Wendy Stevens, Nava Ferdowsi, Maryam Tabesh, Mandana Nikpour, Laura Ross

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Abstract

Objective: To define the frequency and associations of opioid use in SSc. Methods: Australian Scleroderma Cohort Study participants meeting ACR/EULAR criteria for SSc were included. Current or previous opioid use was recorded at each visit, with long-term use defined as use on two or more consecutive visits. Groups were compared using two-sample t-test, Wilcoxon rank sum test or chi-squared test. Generalised estimating equations were used to model longitudinal data. Results: Of 1951 participants with a mean age of 46.7 years (S.D. 14.4), 88% were female and 12% had ever received any opioids since SSc onset. Of these, 46% recorded opioid use across multiple consecutive study visits. Digital ulcers (63% vs 52%), synovitis (57% vs 38%), interstitial lung disease (37% vs 27%), gastrointestinal (GI) symptoms (upper 97% vs 88%, lower 90% vs 80%) and immunosuppression (59% vs 46%) were all more frequent in opioid-exposed groups (P < 0.05). In multivariable modelling, current opioid use at each study visit was associated with digital ulcers [odds ratio (OR) 1.5 (95% CI 1.1, 2.0), P ¼ 0.01], synovitis [OR 1.5 (95% CI 1.1, 2.1), P ¼ 0.02], lower GI symptoms [OR 1.8 (95% CI 1.3, 2.6), P < 0.01] and poorer physical [OR 1.8 (95% CI 1.3, 2.4), P < 0.01] and mental [OR 1.8 (95% CI 1.1, 3.0), P ¼ 0.02] quality of life (QoL). Current opioid use was associated with worse fatigue [regression coefficient (RC) 3.0 units (95% CI 1.2, 4.8), P < 0.01], functional disability [RC 0.2 (95% CI 0.2, 0.3), P < 0.01], dyspnoea [RC 2.0 (95% CI 0.8, 3.1), P < 0.01], depression [RC 2.5 (95% CI 0.9, 4.0), P < 0.01] and anxiety [RC 2.5 (95% CI 0.9, 4.0), P < 0.01]. Conclusions: Opioid use in SSc was associated with musculoskeletal, GI and lung involvement. Opioid prescription was associated with poorer QoL and physical function.

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© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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